Transvaginal Cholecystectomy: A Hybrid Approach Using Our Experience With Notes and Sils

K A Zuberi, MD, J W Hazey, MD, D B Renton, MD, J T Rohl, MD, V K Narula, MD. The Ohio State University Medical Center: Center for Minimally Invasive Surgery, Columbus, OH, USA

 

Introduction:

The idea of using a natural orifice as a means for accessing the abdomen has resulted in novel solutions to common general surgical issues. Hybrid NOTES procedures have proven to be safe and feasible. With a combined flexible endoscopic-mini-laparoscopic approach, a safe and effective method of operative intervention can provide patients with an operation that is less painful and associated with a quicker return to function.

Methods and Procedures:

Approval for this trial was granted by The Ohio State University IRB and data was collected prospectively from a total of 3 patients since 2009. Informed consent was obtained. Preoperative workup included liver function tests and a right upper quadrant ultrasound. Colpotomy was initially made in lithotomy, by a board certified gynecologist. A SILS Triport (Olympus Corp.) was then placed within the colpotomy for instrument access. The cholecystectomy was performed by a board certified general surgeon. A standard 5mm laparoscope was utilized to provide a pneumoperitoneum and visualization of instruments into the peritoneal cavity via the colpotomy. Dissection and removal of the gallbladder was completed with standard laparoscopic instrumentation and a 9mm esophagogastroduodenoscope. Postoperatively, all patients were admitted overnight for observation. Data was collected preoperatively, and on postoperative days 1, 14, at 4-6 weeks, and at 3 months.

Results:

The indication in all patients for the procedure was symptomatic cholelithiasis. The mean time to introduction of a transvaginal flexible endoscope after the official recorded start time was 30.33 min. The mean time to transvaginal gallbladder removal was 52.67 min after the start of the dissection. The average time for the entire procedure was 91 min. Dyspareunia has not been reported as a complication after 3 month follow up in 2 of the 3 patients. Pathology results were consistent amongst all patients, revealing chronic cholecystitis and cholelithiasis.

Conclusion(s):

Our data set shows that the use of a flexible endoscope does not substantially increase operative times in cholecystectomy compared to the national average. Furthermore, this hybrid approach is a feasible technique for peritoneal access, with the endoscope being used with instrumentation and as the only source of visualization after initial laparoscopic access.
 


Session Number: Poster – Poster Presentations
Program Number: P517
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